Thursday, April 28, 2016

Years ago, before I became a dentist, I had the privilege of working for William Barron Hilton and the executives at Hilton Hotels Corp, now Hilton Worldwide. I am fortunate to have enjoyed a previous career committed to numerous large-scale hotels, mentored by great leaders in the hospitality industry.

During that time, my exposure to various departments in that industry taught me a lot about what many authors refer to as “five-star customer service.” I observed firsthand what it takes to teach and deliver this level of service while working with general managers, senior and executive vice presidents, and Hilton himself. The ultimate goal was to provide customer satisfaction at an incomparable level so your guests remain loyal to your brand for life.

The superb teachings, education, and experience earned during my hotel career were ingrained in my dental DNA. As a result, the process of onboarding new employees in my practice incorporated adequate and thorough training so each and every employee understood the culture of providing service excellence without delay. Today, the emphasis on exceptional customer service with a hospitality flare cannot be overemphasized.

You see, the legacy and livelihood of excellent hoteliers such as Conrad Hilton, William Barron Hilton, JW Marriott, Ritz Carlton, and others depend upon offering fantastic customer service and unparalleled hospitality. As dentists, can we learn from this fascinating industry that is open 365 days a year and whose sole mission is to provide exceptional guest services with integrity while doing the right thing 24 hours a day? I think so. For those dentists who are committed, the dental world can be yours. For those who fail to hear the call to action, you are in trouble. It is your business and your reputation that are on the line. With Yelp and the various social media platforms that are available, your patients will not hesitate to tell the world about their poor experiences. How many stars does your practice have?

As we know, and since the Great Recession of 2008, dentistry has become more competitive than ever. Prior to this time, the majority of dentists realized substantial profits while operating with minute business accolades. In the “Golden Years of Dentistry,” cash flow was not a concern. In simple terms, when “cash in” was greater than “cash out,” life was grand. Unfortunately, for most dentists, those days are gone forever and for many reasons: fewer dentists retiring, corporate dentistry, more graduating dentists, in-network insurance providers, price shoppers, fierce competition, etc. However, to the dentists who are willing to change and adjust to the new dental world: Your “golden years” are right in front of you.

While difficult for most of us to acknowledge, the fact is that 99 percent of a doctor’s academic credentials are science-based and not substantive in the business acumen required to provide five-star customer service.

Five-star customer service definitely has a place in dentistry. For those clinicians and business owners who embrace change while recognizing the value of developing, nurturing, and creating great teams, your future is limitless. Combined with wonderful clinical skills and team members who are dedicated to providing each and every one of your guests with five-star service, your practice can define excellence and set the standards for your entire community. Learn to hire employees who possess tremendous enthusiasm, a positive attitude, and a passion to serve others. As we like to say in our practice-management firm, “Hire up!”

Our future success and autonomy now depend upon delivering exceptional customer service with integrity, leadership, teamwork, and ownership. While our clinical skillsets are important, they are no longer the differentiator between where patients seek care and decide to spend their hard-earned monies. As dental business owners, we must learn to be passionate about delivering exceptional experiences so our “guests” (patients) do not go elsewhere. Today, it should start with every one of your existing patients. Learn to protect, nurture, and show your appreciation so that your “guests” tell the world about how great your office and team are. This form of internal marketing is one of the greatest assets you possess — and the wonderful news is that it is free!

As a dentist and practice-management consultant, I have had the pleasure of evaluating and working with many solo, group, and large-scale dental practices, one of which had more than 600 clinicians. I have witnessed the most common pitfalls of dentists and corporate dental executives at all levels. It all starts with leadership and the ability to create a vision that is passionate about delivering exceptional patient experiences. In other words, building teams that enliven the senses while implementing processes and systems, role-playing, and showing a commitment to five-star customer service that will keep your “guests” coming back.

While important, there is no external marketing or magic bullet that will ever replace “service with a smile,” a “be-my-guest” philosophy, and a sincere commitment to a culture of caring for others. If you find your office in decline or idling in today’s new dental economy, it might be a good idea to reach out for professional guidance and have a best practices analysis performed. A proper diagnosis is critical to mastering the business of dentistry with a hospitality flare.

Tuesday, April 26, 2016

Having a strong team is directly proportional to how successful you are. You may consider yourself to be the best clinical dentist in the state, but if you don’t have a team who supports you, no one will ever know that. So, how do you know if you have the right players in your office? Here are three questions to ask yourself so you can check in on how effective your team is:

Does each individual believe in your practice philosophy? This question is the most important. Every single person who you employ must value and demonstrate your mission statement. You shouldn’t employ anyone who doesn’t buy into your goals, your beliefs, and what you are trying to achieve. I’m not saying that your employees should be replicas of you. However, your team is an extension of who you are professionally, and your team members should be the reflection of your mission statement. When your office is reviewed, it’s not just about you or your quality of care. The review is based on a patient experience with you and your team. If you have a mission statement written down, review it monthly as a guide to see if everyone is following the set goals.

Are you delegating responsibilities to team members and empowering them? In my opinion, the only thing a dentist should do in the office is take care of the obligations others cannot legally do. In the most productive and efficient practices, you’ll find the dentist has delegated as much responsibility to his or her team as possible. The assistants and hygienists have their own schedule, while the dentist comes in and addresses only what he or she is clinically responsible for. This model of practice frees up the dentist’s time while simultaneously creating production for the assistants and hygienists. Of course, every person must be trained appropriately and feel mastership of the procedure the dentist has delegated to them. This means countless hours of hands-on training and traveling for continuing education. I find this type of investment in people to be priceless. It brings greater success to a practice and inspires dental professionals to grow.

Do you enjoy working with your team? I believe you must like being around each person in your office. Every member in my practice is a completely different person than the other, and each one brings a unique perspective and experience to the office. I love that about my team. I genuinely enjoy spending time with everyone, whether it’s as a group, chairside, or individually. I won’t ever work again with someone who I don’t like being around for any reason. Most people spend more time at work than anyplace else. Isn’t it important to be around people who make you happy?

As business owners, we need to be leaders and innovators. Our teams need to be comprised of managers, producers, cheerleaders, and cultivators. If you try to do it all yourself, you may find one day that you are all by yourself.

Wednesday, April 20, 2016

I don’t know how I heard of silver diamine fluoride (SDF) in the first place, but it has blown my mind ever since I have found it. You may have heard of silver nitrate — the stuff we put on ulcers to burn them up. This is also what some dentists were using to arrest caries.

Now there is something new (U.S. Food and Drug Administration-approved in 2014 and the first product on the market in 2015) that is actually made to arrest caries.

Wait? What?!

Yeah, that is what I said.

You take this SDF liquid and put it on a cavity, and it arrests the progression of decay and builds a secondary dentin layer at the same time.

Because it is so new, there is not much on it on the Internet. There are a lot of studies on rats and some research on people in China, but few have been published in the United States. (All of the studies say the same thing: The stuff works.)

Think of the implications. You rub it on a cavity, and the decay stops.

You have a 3-year-old who won’t sit still who has decay on his or her teeth. The parents don’t want to put the kid under anesthesia. All the dentist has to do is rub some SDF on all of his or her decay, and the procedure is done.

When you go back four to six weeks later, the dentin bridge is so strong that you can drill on the teeth without anesthetic.

Wait? What?! Yeah, that is what I said.

Think of the implications. For a youngster who has decay on the facial of No. C, use a little rub of SDF on the cavity at the cleaning appointment. Four weeks later, you can complete the filling in about three minutes, and the patient is done.

How about Henry, who has been coming to your practice forever? Henry is diagnosed with cancer and is in failing health. He is on tons of meds, and the chemo is drying out his mouth. He is getting decay everywhere. You try to do 10 facial fillings. You see Henry on recall, and he has 12 more spots of decay. You put SDF on and around all of his teeth. You don’t even have to do the restorations. At least you know that his decay isn’t going to progress.

How about all of us who go on mission trips and see so much decay that one week of dentistry is equivalent to throwing a piece of sand in the ocean? How about buying the third-world country clinic a case of SDF? They would wipe it on an already black spot, and that person would keep that tooth.

OK, so here is the catch. (Yes, there is always a catch.) The only side effect of this liquid is that it turns all decay black. In all the articles that I have read, this is the only drawback.

Do you think the youngster will care if his or her brown spot of decay turns to black? Do you think Henry is going to care that all of his brownish/orangeish roots become black on the distal ling surfaces? Do you think the child in rural Mexico is going to care? Maybe, but sometimes the patient will just be happy not to have to sit in your chair and spend dollar after dollar.

Look it up. It is new, so there is only one product on the market. I am sure this is going to be big — so big that someone probably is going to make some formulation that doesn’t turn the decay black.

Do you use SDF? Let me know if you find out something I am missing. I am so excited about what the future holds with this stuff and beyond.

Friday, April 15, 2016

A trip to the dentist can be frustrating for a variety of reasons: the cost, a lost personal or sick day, the feeling of being worried about your health and well-being. These concerns are difficult enough, but they can be exacerbated by poor or nonexistent patient communication. Improving communication between a health care provider and a patient can have fantastic results for both customer satisfaction and patient compliance. Achieving smooth dentist-patient communication may be a difficult, but following some simple advice can make the process much easier.

Dentist and Patient Communication: An Overview
A 2005 study on dentist-patient communication conducted by the University of California, Los Angeles found that “the dentist’s ability to communicate clearly and effectively is one of the underlying factors assuring a successful dentist-patient relationship and the key to all outcomes of the dental practice.” Improving your patient communication can have a positive impact on the patient’s well-being. Establishing a clear dialogue with a patient can be difficult, but the benefits are substantial enough to require the effort.Communicate Uncertainty
Everyone has a different personality and reacts to pain or hardship in his or her own way. On top of that, people have various education levels and understandings of medicine, biology, and anatomy. While it can be tempting for dentists to answer any question with certainty, a patient could become upset or frustrated if the outcome is dramatically different from the prediction. If you don’t know the answer to a question, then simply say, “I don’t know.”

Remember: Patients Are Not Dental Professionals
To receive a DDS or DMD degree, years are spent learning and practicing unique specialties among health care professionals. This result is gaining a level of comfort with advanced technical terms that is not usually shared by members of the general public. When speaking with patients or their families, dentists should communicate as plainly as possible. Telling a patient he or she has periodontitis can unnecessarily frighten the patient, when he or she only has gum disease. Discussing diagnosis or treatment options in simple terms encourages patient involvement.

The Qualified Professional Has the Final Word
While the vast majority of patients will be grateful for clear communication, others will take advantage. Some people interpret explanation or dialogue as negotiation. In some instances, the input from a patient or his or her family is vital to making a treatment decision. In other cases, a dentist’s decision is final. There are always second opinions, and communicate that option, but health care professionals have a duty to rely on their training and experience in making the ultimate determination about health care. If an open channel of communication is leading to unproductive areas, feel free to reiterate your recommendation and end the conversation. A dentist has a duty to serve his or her patients but not at the expense of their careers or livelihoods.

Wednesday, April 13, 2016

One of the best days in the dental office is when someone comes in and wants services from you. It likely means you have formed a relationship with them — that they trust you — and that makes you feel pretty good about yourself. You are doing work that you love on someone who trusts you — and they pay you (this is like dental utopia).

Yet even with all that, so many things can go wrong, and most of the time, they do. This is something I know from personal experience, and I’m going to tell you about it now.

So we all know that the cementation appointments have the least risk/reward in dentistry. Margins can be open, the veneers can be too short, embrasure spaces can be too open or closed, the bite can be wrong, the color can be too gray or too yellow — oh my gosh, I am getting stressed out just typing this!

And, then, let’s say you do like the finished product and cement them in. The patient is numb, so they can’t appreciate the beauty of your work; they might even be disappointed when they look at them for the first time. And if they do like them, there is a good chance that you cemented them in even though you didn’t think they were perfect.

“I thought they were too white.” “Did you see the corner of distal line angle on No. 7? It was rounded and the distal line angle of No. 10 was straighter!” “They had an existing crown on No. 7 that we just couldn’t match just right.” We are critical to the point where we can’t be satisfied. (Am I the only one that sabotages my own happiness? Please tell me I am not.)

But I digress. Back to the story.

Two weeks ago, I had a 25-year-old come in to get veneers on her front eight teeth. She saved for about five years for the procedure, and the appointment went great on all fronts. She was so happy from the beginning, and I was thrilled to be able to help her with this — I mean, I was thrilled to have the skill to change someone’s life.

We had a great time. We did some minimal preps; I took impressions and made her some very nice temps. A couple weekslater, it was time to cement the veneers in. She was so excited about this appointment, but I was a bit reserved because I know the risk/reward is not in my favor.

We removed the temps and tried them all in. I liked about 80 percent of them — and that’s good. Changes needed to be made, but there’s an American Academy of Cosmetic Dentistry lab a mile from my office, so if I ever need adjustments, I can quickly run them over. After the changes, they were ready to be cemented. I was pretty happy, which is rare.

Then came the question that will live in infamy: “Doctor, what cement would you like to use?”

Now, this is why our profession sucks sometimes. There are about 40 answers to that question. Some dentists use warmed resin for this; some use flowable. Some use resin cements, which have about four or five categories.

I looked at my assistant and told her that we have been using that “new and improved stuff” that has been working well. It was a self-adhesive dual cured cement.

Remember when I told you that I minimally reduced the preps and all the margins were on enamel. Come to find out, that self-etch adhesive resin cement doesn’t work that well on enamel. I picked the wrong cement.

Oh man, the cementation went great. It was so easy to use, and after we polished, the veneers were awesome! Show quality. So much so that after she left, I even said, “Man, those turned out nice.”

It was about three hours later, as I was coming home from my son’s baseball practice, when I got the dreaded text: “One of my veneers have come off.” Three hours after that: “Another one of my veneers just came off.”

The next day — which was already full — I had to fit the patient into the schedule in order to cement the eight veneers all over again. Yes, I said all of them. By the time she came in they had all fallen out. My technician removed all of the cement, and they were good as new.

This time, we used the old tried-and-true cement. You know, the one that has about a four-minute working time. I prepared the veneers and the teeth and began to put them on. After I put them all in, I started to remove the cement from the first one, and then the next one and so on. I was getting a little antsy, though, because the material was getting pretty hard at this point.

I got cement everywhere. I began to floss, having my assistant holding down adjacent veneers, and I have to tell the patient that this is going to get a little rough, because for some, it’s hard to get the floss through.

Once I finally finished, I was a mess, but the patient was happy about getting new teeth. I finished polishing the beauties and then took take her to the front desk. I apologized to her for the inconvenience, yet she was still excited, smiling from ear to ear.

Then, for me, the doubt crept in. Did I use the right cement, will they come off again?

I was relieved but worried that they may come off again.

For the next six months, I will think of this patient often, probably cringe, and then hope that things don't fail. The same will happen next year, and it probably won’t be until the five-year mark that I might be able to take a deep breath and think of the procedure as a success.

Success and failure — it is what the “practice of dentistry” is all about. We are all our own biggest critics. We take responsibility for things we are responsible for, and we take responsibility for things we are not responsible for. And I know I am not alone in feeling this way.

Work is always busy, life at home with my family is always busy, but I try to have perspective — and so should you.

We have great jobs and great lives. Sometimes, we’re just moving too fast to realize this. Most days, I still feel as if my head is on a swivel. I still feel like, one day, I am going to finally get this. I still feel like it will all come together soon.

Monday, April 11, 2016

I spend way too much time on YouTube, I confess. And you know how watching a video leads to watching another, and before you know it, you’ve gone down a rabbit hole trying to figure out what led you there?

I started out watching a video about building an electric guitar, and after exhausting all the videos on that, I noticed a related link to a Japanese luthier building violins. In Japanese. And I watched it. Oh, there’s a video of a guy forging knives from automobile springs! In Russian! I must watch!

So, after reaching a low point, I resorted to watching dental videos. Crown preps, Class II restorations, crown-lengthening surgeries, endo techniques, blah, blah, blah. I’m always fascinated by the myriad ways common tasks can be accomplished. Everybody has their own way for their own reasons. I can respect what works for each individual.

But not everyone is so understanding. And the anonymity of the Web allows for people to be complete jerks when they disagree with something.

I was watching a video of a dentist restoring a carious lesion on the mesiolingual of a maxillary lateral incisor with composite. He was narrating this procedure in layman’s terms so that the general public could understand what he was doing and why. I thought he explained it well for the audience for which it was intended.

But, as usual, the comment section was where the trouble was. Someone, a dentist I assume, asked: “Why are you using a <expletive> drill? I use a microetcher instead of <expletive> drilling everything out.”

Well, that escalated quickly!

So this is what modern discourse has come to? One dentist is so wedded to a technique that works well in his or her hands that someone who dares to accomplish the same task using a different method is worthy of such scorn? I’m not such a prude that I’m offended by the language, but why can’t the question be posed in a more civilized way?

I promise not to pile on the negativity if you want to use Copalite under a composite. Whatever works for you.

Friday, April 8, 2016

P.F. Peek Freans: The makers of biscuits. Started in the mid-1800s in London, my favorite is their shortbread cookies with the letters “PF” in the middle. There are better shortbread cookies made, but these were the first ones that I remember, and they always take me back to my childhood.

P.F. Percy Faith: My mother’s oldest brother. Born in Toronto in the early 1900s, he became a composer and arranger of popular music in the 1940s, ’50s, and ’60s after losing his ability to play the piano when he used his hands to put out a fire that was burning one of his sisters. Percy Faith later became one of the most prolific recording artists ever, with more than 50 albums recorded. He has won Grammys, has been nominated for Oscars for his soundtracks and an Emmy for the music he wrote for “The Virginian” TV series, and more. I grew up listening to my Uncle Percy, as well as classical music, and although I had some talent, a career in music was not what I desired. For me, music is my joy. I did not want it to be my work, too. (Perhaps I did not really have enough talent….)

P.F. Pierre Fauchard: The father of modern dentistry. A physician, born in Paris in 1678, he wrote the first modern textbook of dentistry, “Le Chirurgien Dentiste (The Surgeon Dentist),” in 1728. I received an English-language translation of this textbook, published in 1946, by my colleague, Dr. Roy Rasmussen, as a gift after my successful purchase of his dental practice 22 years ago. Pierre Fauchard wrote the book in an effort to teach “in which is seen the means used to keep ‘teeth’ clean and healthy, of beautifying them, or repairing their loss and remedies for their diseases and those of the gums, and for accidents which may befall the other parts in their vicinity.” This amazing textbook elevated dentistry to become a profession. Dr. Rasmussen hoped I would treasure this amazing gift, and I have.

P.F.A. The Pierre Fauchard Academy. Founded in 1936 by Dr. Elmer S. Best, a dentist from Minnesota, this honorary dental service organization was created to help our colleagues gain control of our literature and assure its independence from commercial interests, according to www.fauchard.org. It is best known for the publication of “Dental Abstracts.” Now a worldwide organization, The Pierre Fauchard Academy hugely supports various charitable efforts locally, nationally, and internationally, amongst other various activities.

On March 18, 2016, in Vancouver, British Columbia, I was welcomed into the P.F.A. as a new fellow. To be honored by our peers at this time is a thrill, especially when, in my opinion, some of us face turbulent times in dentistry, with our regulatory bodies and agencies becoming ever more strident in their restriction of our speech.

Letters. On their own, and collectively, they have so much meaning. I have now been honored by our peers four times. But my biggest honor is one I have yet to earn: a Fellowship from the Academy of General Dentistry (AGD). I just have to get over my exam anxiety and make it happen.

Wednesday, April 6, 2016

This is a topic I’ve been irked by enough over the past few months to write about it and share with you wonderful folks! So bear with me. I hope I don’t raise too many eyebrows or ruffle serious feathers.

Here it goes. A patient presents to your office for a new-patient consultation, with “sensitivity UR.” Your patient care coordinator schedules 30 minutes. It’s probably just buccal recession, requiring a sensitivity relief treatment of some sort, or a discussion on clenching or grinding. Pretty basic, right? Your assistant seats the patient and asks him or her to explain the problem. And then it happens.

As soon as the patient opens his or her mouth, the assistant tightens the mask a tad and puts on safety glasses. This patient has rotten teeth — significantly compromised, full-mouth rehabilitation, not “sensitivity issues.” The assistant politely tells the patients that the team will be taking a series of X-rays to find out what the sensitivity is all about. See, most assistants don’t like conflict. They don’t like to call the patient out (and most of the time, I appreciate that). Instead, they gather all the necessary diagnostic data and come running into your office.

“Dr. Murry, you’ll never believe this mouth. Plug your nose, double mask, wash your hands, put on your hazmat suit … it’s nasty.” Now there’s my assistant who I know and love! You take a look at the X-rays in your office; it’s always better to get the shock, awe, and four-letter swear words out of the way well out of patient’s view. You prep yourself, and off you go.

Introductions in the operatory, discussion of chief concern, and then into the intraoral exam. You don’t even really need to look. You know the story. But you oblige. Five minutes later, the mirror hits the counter, the gloves come off, the mask is pulled down, and your chair moves so as to be face-to-face with the patient.

Now stop. Time out!

This is where so many of us get it wrong. Ask me how I know. I’m seeing many of your patients because of it! I call it tooth shaming. There’s a fine line we have to dance along when presenting clinical findings of this manner with patients. Yes, they need to hear it honestly and sternly. And yes, it’s our duty to present to them our findings in regard to their dental health. But darn if we can’t do that in a way that doesn’t embarrass, anger, emotionally charge, or downright belittle a patient! I can’t even count how many patients present to my practice in tears, not because someone has hurt them during a dental treatment in the past, but rather, the dentist down the street they saw two years ago made them so depressed and upset about their teeth that they have been hiding from any dental office since then. Heck, the last one even told me the dentist laughed after looking at her teeth.

Are. You. Kidding. Me. Please tell me none of you have ever done that. A tooth is such a personal, vulnerable body part to most people. We have to harness this vulnerability and treat it as sacred. It’s not to be joked about. We can really mess with a patient’s mental and emotional well-being if we misuse or mistreat his or her trust. It’s an honor, really. And a privilege. Let’s not forget that.

They know they’re not in for “sensitivity UR,” but they are hoping we’ll ease it. They’re hoping they don’t have an experience like their last one. And, honestly, I’m going to come up with the exact same treatment as the last guy, but I’m going to make it a positive, uplifting experience. I won’t give away all my secrets to patient conversation, but needless to say, tell them it will be OK. I always lead with, “I have great news. I can help you!” Nothing in their mouth is anything we haven’t seen (or treated) before. And if it is, we know great specialists who can assist in the treatment.

So after those gloves come off, the mask is pulled down, and the chair is moved, take a two-second mental timeout. Take a breath, and turn on the tooth-shaming filter.

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The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.

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The purpose of The Daily Grind is to offer readers a glimpse into the life of general dentists practicing today. Each post offers a perspective on managing a dental practice or balancing a life outside of the practice. The Daily Grind is written by several general dentist and student members of the Academy of General Dentistry.

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